Medicare Annual Wellness Visit ICD-10-CM codes

Medicare does not define a specific diagnosis code for the annual wellness visit, and most carriers accept Z00.00 (general adult medical examination without abnormal findings) as the first-listed diagnosis for G0438 (initial AWV), G0439 (subsequent AWV), and G0402 (the one-time Welcome to Medicare visit within 12 months of Part B enrollment). Use Z00.01 with a secondary code if the visit produces a new abnormal finding. Chronic conditions reviewed as part of the health risk assessment are listed after the Z code.

The AWV is not a physical exam and is not billed with 99381 to 99397. A problem-oriented E/M visit can be reported on the same day with modifier 25 when a separate problem is managed, but that service needs its own diagnosis; Medicare does not want the chronic conditions used to justify both the AWV and the E/M.

Several separately payable preventive services attach to the AWV, each with its own Z code: Z13.31 with G0444 for annual depression screening, Z13.6 for cardiovascular screening blood tests (80061, 82465, 83718, 84478), Z13.1 for diabetes screening (82947, 82950, 82951), Z13.820 for the bone density study (77080), Z12.11 for colorectal screening (G0121, 45378, 81528), Z12.31 for the screening mammogram (77067), Z11.4 for HIV screening (G0475), Z11.59 for hepatitis C screening (G0472), and Z71.6 with 99406 or 99407 for tobacco cessation counseling. Medicare lists the diagnosis it wants for each benefit; using the wrong screening code (for example Z13.220 instead of Z13.6 on the lipid panel) is a common cause of denial.

Advance care planning done at the AWV (99497, modifier 33) has no dedicated Z code; Z71.89 (other specified counseling) is accepted, or the patient's terminal condition if that is what drove the discussion. Z91.81 (history of falling) supports the fall risk portion of the visit, and Z13.39 covers cognitive or substance use screening beyond depression.